Provider Demographics
NPI:1699856286
Name:PANIOLO COUNTRY PEDIATRICS LLC
Entity type:Organization
Organization Name:PANIOLO COUNTRY PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ROSS
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-887-6543
Mailing Address - Street 1:PO BOX 6149
Mailing Address - Street 2:
Mailing Address - City:KAMUELA
Mailing Address - State:HI
Mailing Address - Zip Code:96743-6149
Mailing Address - Country:US
Mailing Address - Phone:808-887-6543
Mailing Address - Fax:808-887-6294
Practice Address - Street 1:64-1032 MAMALAHOA HWY STE 204
Practice Address - Street 2:
Practice Address - City:KAMUELA
Practice Address - State:HI
Practice Address - Zip Code:96743-8441
Practice Address - Country:US
Practice Address - Phone:808-887-6543
Practice Address - Fax:808-887-6294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-18
Last Update Date:2015-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI0000235200OtherQHMS, DR. KAPLAN
HI50529001Medicaid
HI50672701Medicaid
A004OtherCHAMPUS, DR. KAPLAN
HI00226101Medicaid
HI3573421OtherUHA, DR. KAPLAN
HI9587421OtherUHA, DR. GREGG
HI0000227603OtherQHMS, DR. LEE
HI00A0211829OtherQHMS, DR. GREGG
A003OtherCHAMPUS, DR. LEE
HIA21182OtherHSMA, DR. GREGG
HI022760OtherHMSA, DR. LEE
HI2314421OtherUHA, DR. LEE
A002OtherCHAMPUS, DR. GREGG
HI023520OtherHMSA, DR. KAPLAN
A002OtherCHAMPUS, DR. GREGG
HI50672701Medicaid